Mental Status Examination:
Appearance: well-groomed, clean, and normal weight. Behavior: calm, pleasant, eye contact, and guarded. Speech: fluent, clear, and soft. Perception: no hallucinations. Cognition: oriented to situation, time, place, and person and alert and memory intact. Intelligence: average . Memory: remote and recent. Mood: euthymic. Affect: anxious and flat and euphoric and congruent to thought content. Insight: intact. Judgment: intact. Thought Processes: intact. Thought Content: unremarkable. Motor Activity: intact.
Differential Diagnoses:
Bipolar II disorder
This patient has a history of previous hospitalization where a diagnosis of bipolar II(depressive type), was made. For a diagnosis of Bipolar II, the DSM-5 (2013) states it is characterized by at least one hypomanic episode and one or more major depressive episodes.
Patient has a history of attempted suicide at the age of 13, indicating a depressive episode and a family history of Bipolar disorder. According to O’Donovan, C. et al; (2020), of people presenting with an episode of major depression, a certain proportion may in reality be suffering from depression that is of bipolar type.
This could be for several reasons: in many if not most cases bipolar disorder starts with symptoms of depression and first hypomania/mania may not appear until years later; depression is considered a part of the bipolar genetic spectrum and thus some forms of depression are conceivably variants of bipolar disorder, particularly in those with a strong family history
Major Depressive Disorder
Studies have shown there are distinct biomarkers that distinguish unipolar depression frommthe depressive state in Bipolar disorder. Menezes, I. et al; (2019) report that
Clinical studies have shown about 40%–50% of BPD patients are firstly erroneously diagnosed with MDD and the correct diagnosis use to be delayed about 8-10 years
BPD is characterized by recurrent episodes of depression and elevation of mood (mania and/or hypomania), being in a depressive state more frequent, longer and disabling than hypo/manic state in BPD .
Bipolar patients are more likely to have a family history of BPD, greater number of affective episodes, psychiatric hospitalization, suicide attempts, and earlier onset of the disease than unipolar depressed patients. This patient was first diagnosed at 19, attempted suicide at 13, and has a family history of Bipolar disorder, making Bipolar II disorder my first choice as a differential diagnosis.
Attention Deficit Hyperactivity Disorder (ADHD)
Patient reports that her mind in constantly racing and she has difficulty concentrating and finishing tasks. Pinna, M. et al; (2019) state the symptomatology of BD and ADHD can overlap, with mood instability, distractibility, bursts of energy and restlessness, talkativeness, racing thoughts, impulsivity, impatience, impaired judgment, and irritability found in both disorders
While this is not my first choice, I believe more indepth interview may need to be carried out as patient may have ADHD as a comorbid condition with Bipolar disorder.
Reflections
In the course of doing this assignment, I came to realize how important it is for a mental health clinician especially, to thoroughly assess their clients, and to rule out substance abuse dependence and medical conditions that may present as psychiatric disorders, prior to making their diagnosis as even abnormalities of the immune system, including thyroid dysfunction, might be a potential factor contributing to the development of these mental disorders (Jucevičiūtė, N.et al; 2019).
Important legal documentation prior to treating patients was also evident in this case presentartion as patient had to sign a release form in order to request medical record from previous Provider
All the appropriate tests, interviews and assessments were done prior to this patient being diagnosed with a bipolar 11 disorder-ruled out medical and drug causes of pt symptoms. (medically stable with normal lab TSH,CBC,A1C. Pt denied the use of any street drug)
Although there is no record here indicating family and friends were interviewed, I would assume they were, as it is important to seek input of patient behavior from other close sources to make a this diagnosis of Bipolar 11.
According to Wheeler, K. (2014), while medication is considered the first line of treatment is Bipolar disorder, multiple studies have shown with increasing evidence that the course of the disease can be further modified by interventions that target the three factors associated with relapse in BD; stressful life events, medication non-adherence an
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